Please note that our policy is very restrictive in terms of no-shows or cancellations. ONCE AN APPOINTMENT IS MADE, IT CANNOT BE CANCELLED without 5 business days notice. You have made a commitment for that day and time for that staff member and it cannot be easily filled with another patient (or filled at all).

If there is a serious illness or emergency event that would prevent you from coming to your appointment, you must contact our office as soon as possible and speak directly to your provider or one of our staff. Simply leaving a message on the phone will not relieve you of your responsibility to come to the appointment, talk directly to your mental health provider, and pay for your allotted session. Note that insurance companies cannot be legally billed for a no-show or cancellation where you did not attend any part of the session. This will be your responsibility.

THE FEE for a no-show or cancellation is $100.00 for a psychotherapy or psychiatry appointment, and $300.00 for a psychological or neuropsychological evaluation.

The fee will be waived if you are able to reschedule the appointment in the same week (depending upon the availability of your mental health provider. The fee may be waived for special circumstances upon discussion with your mental health provider or Pam Selph, Executive Administrator.

HIPAA and Forensic Consent

April 14, 2003 marked the date that healthcare providers and others must come into compliance with HIPAA. This provides you with additional rights and creates a number of obligations on our part. The Federal government now requires us to obtain your signature that we have provided you with a HIPAA Privacy Notice. This notice explains to you how your health care information (even just your name or other identifying information) may be used.

Given that psychologists, counselors, and psychiatrists have always had a special responsibility to maintain confidentiality, Comprehensive MedPsych Systems staff have always taken this seriously. State and Federal regulations as well as administrative rules by the Florida Department of Health and Board of Psychology also govern how your confidential information is used or released. We also have American Psychological Association ethical guidelines we must adhere to as well.

Please note, Worker’s Compensation, Automobile Insurance, Disability matters, and other payor systems which involve or could potentially involve litigation fall under other rules and may not be bound by HIPAA. In such circumstances, you will not be asked to sign the HIPAA form but will be asked to sign the Forensic Consent Form.

CONSENT for TREATMENT or EVALUATION

We cannot treat you or attempt to collect payment from any source without your signed, written consent.

RELEASE OF INFORMATION

Please note that we cannot release information without your consent except under the following circumstances in which we are bound by law:

You are in imminent danger of harming yourself or someone else

There is suspicion of child abuse or neglect

There is suspicion of elder abuse or neglect

There is suspicion of abuse or harm to a disabled individual

There is suspicion of an inappropriate sexual relationship with another healthcare provider

If legal action is brought which specifies mental health damages

If there is a court order signed by a judge

RELEASE OF RAW PSYCHOLOGICAL TEST DATA

Please note that while you may have a right to most of your psychological and psychiatric file information, raw psychological test data (computer printouts, forms, scores, test protocols, test questions, or written answer sheets, etc.) cannot be released directly to you as a patient, a lawyer, or any other representative according to the legal statute: Florida Board of Psychology Rule 64B19-18.004(3). According to this statute, we can send raw data to a qualified licensed psychologist with a proper signed release form. This statute specifically restricts the release of raw test data except to a licensed psychologist, by court order or unless otherwise required by law.